This review examines controlled studies of the psychosocial adjustment of adult children of alcoholics (ACOAs) published since 1988. ACOAs appear at increased risk for a variety of negative outcomes, including substance abuse, antisocial or under-controlled behaviors, depressive symptoms, anxiety disorders, low self-esteem, difficulties in family relationships, and generalized distress and maladjustment. However, none of these outcomes are uniformly observed in ACOAs and none are specific to ACOAs. Comorbid parental pathology, childhood abuse, family dysfunction, and other childhood stressors may contribute to or produce similar outcomes. There is little empirical support for "ACOA syndromes" described in the clinical literature.